Most women diagnosed with ovarian cancer suffer through difficult disease course that has a poor medical outcome. Our research has suggested that levels of general and cancer-specific distress are elevated after diagnosis and that cancer-specific distress remains elevated over time. Unfortunately, there have been few empirically-based psychological interventions for this population. Over the course of the past 8 years, we have tested the efficacy of two psychological interventions, a supportive counseling intervention (SC) and a coping and communication skills intervention (CCI), for this patient population. Our results have suggested that both interventions reduced depressive symptoms and have indicated that SC is more effective among women who are more expressive of positive emotions and women who experienced increasing disability. The goal of the next proposed study in our program of research is to extend our research in the following ways: 1) To evaluate the long term durability of these interventions, particularly among women who experience a disease recurrence; 2) To assess unique and shared mechanisms of change by using a more appropriate methodology to assess mediation and by focusing on emotional processing and benefit finding as a unique mechanisms for SC and by assessing additional cognitive and behavioral skills that are taught in CCI as unique mechanisms for CCI; 3) To examine the impact of CCI versus SC and UC on a broader range of psychosocial outcomes including worries about disease recurrence and global (e.g., social functioning) and spiritual quality of life. 401 women who are newly diagnosed with ovarian cancer will be randomly assigned to CCI, SC, or UC. Participants will complete surveys pre- intervention, 5 weeks, 9 weeks, 6, 12, and 18 months post-baseline. The primary aims are: 1) To evaluate the efficacy of CCI, SC, and Usual Care (UC) on patients' long-term general and cancer-specific psychological adaptation, concerns about recurrence, and quality of life, and to determine whether either treatment's effects are moderated by disease recurrence. 2) To evaluate the cognitive, social, emotional, and behavioral processes which mediate CCI and SC's effects on patients' long-term psychological distress, concerns about disease recurrence, and quality of life. PUBLIC HEALTH RELEVANCE: Our prior research has indicated that about 25% of women diagnosed with ovarian cancer report significant depressive symptoms and nearly 70% report significant cancer- related distress. We have evaluated two interventions, a cognitive-behavioral intervention and a supportive counseling intervention and found that both interventions significantly reduced depressive symptoms. In this renewal application, we seek to extend this program of research by evaluating the long-term effects of the interventions, by assessing unique and common mechanisms of change, and by expanding our assessment to a broader range of psychosocial outcomes.